Last year was an evolutionary one for healthcare, with the widespread adoption of telehealth providing patients with access to providers at their fingertips.
While telehealth certainly expanded access to care and orthopedic care accelerated toward the outpatient setting, spine providers continue to address ongoing industry challenges including the reshaping of value-based care programs and battles with CMS and commercial payers.
Bundled payment programs
"The biggest challenge facing our practice is promoting value-based care with appropriate incentives for all stakeholders," Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, told Becker's.
While bundled payment programs for spine surgery have been shown to deliver considerable cost savings per episode of care, reduce infection rates and decrease complications, payment models and aligning stakeholders remains a significant challenge.
"The baseline target in CMS bundles are adjusted from the previous year's total cost of care, providers experience diminishing return and are not incentivized to improve dramatically — as doing so could significantly alter target prices and potentially reduce shared savings significantly," Dr. Vaccaro said. "Under the current bundled payment scheme, the dramatic diminished marginal benefit to the provider must be rethought to maintain alignment in order to further flatten the cost curve of medicine today."
Payer battles
Many spine providers see prior authorization requirements as unjustified and unnecessary, with CMS set to enact further prior authorization regulations for cervical fusion with disc removal and implanted spinal neurostimulators in July.
Surgeons must use the words and phrases that CMS and commercial payers look for to minimize denied claims, but they are becoming increasingly frustrated that payers are not being held accountable for delaying patient care and require more steps before care can be delivered.
"We are spending a lot of time and resources on the preauthorization process. The guidelines for each insurance company are a moving target," said Alok Sharan, MD, of Awake Spinal Fusion in Matawan, N.J. "Certain insurance companies are requiring specific words to be used in imaging reports, while other insurance companies have no specific requirements. Often our patients are in pain and their surgery is delayed as a result of this preauthorization process."
Physician practices will need to increase staffing to address the incoming regulations, which providers see as unnecessary rules that will stifle access to care.
In addition to being disruptive to patients' and surgeons' schedules, battles with payers and coverage denials have also stunted the introduction of new technologies, according to Michael Musacchio, MD, of Evanston, Ill.-based NorthShore University HealthSystem.
"There are innumerable excellent and useful products for spine surgery that are simply inaccessible in the U.S. due to insurance coverage questions, even when they are FDA approved," Dr. Musacchio said. "The insurance coverage process needs to change for patient care to experience ongoing meaningful improvements."
Maintaining staff
Amid a nursing shortage and the COVID-19 pandemic, maintaining quality nurses has presented a significant challenge for spine practices over the past year.
"While it seems to be improving now that the vaccinations are rolling out and the numbers are going back down, we remain fearful of another spike," said Robert Bray Jr., MD, CEO of DISC Sports and Spine Center in Newport Beach, Calif. "We also saw significant growth in cases, as patients did not wish to be cared for at hospitals during this time. A combination of increasing patients seeking the outpatient environment and decreased available healthcare providers has made 2020-2021 a very challenging time."
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